Uppehållsrätt och frontlinjebyråkrater

This study focuses on two key elements. The first is the implementation of EU directive 2004:38 in Sweden and how the right of residence is determined by three Swedish authorities. The second is how well Michael Lipsky’s theory on street-level bureaucrats can describe the reality of the civil servants who work with determining the right of residence. The material for the study is the actual text of EU and Swedish law on the subject, the guiding documents from the authorities in Sweden and also interviews conducted with the street-level bureaucrats from each respective authority, The Swedish Social Insurance Agency, The Swedish Migration Board and The Swedish Tax Agency. The findings show that the implementation has caused certain problems both for individuals seeking to reside in Sweden as well as for the civil servants working in this field. This is mainly because the separate authorities have to decide on the right of residence separately and there are differences in how they determine the right of residence. The street-level bureaucracy theory is in many ways an accurate depiction of the reality in this field and can be used to describe as well as understand the problems with the work at these authorities

L'engagement de l'infirmière dans le respect des choix des personnes confrontées au cancer du poumon: travail de Bachelor

Problématique. Le cancer pulmonaire est une maladie qui peut engendrer des troubles psychosociaux. Ces troubles mènent à une détresse psychologie qu’il peut être difficile de surmonter pour les personnes qui vivent cette expérience de santé. Afin d’atténuer cette souffrance psychologique et leur offrir une meilleure qualité de soins, les compétences de communication de l’infirmière sont primordiales pour accompagner la personne dans le processus de sa maladie et dans la détermination de ses choix. Le but de cette revue littéraire consiste à mettre en évidence le rôle de l’engagement de l’infirmière, à travers la communication, afin que les choix des personnes confrontées au cancer pulmonaire soient respectés, en préservant leur dignité et leur liberté. Le cadre théorique s’appuie sur le paradigme de l’humaindevenant de Rosemarie Rizzo Parse qui invite à pratiquer l’art des soins infirmiers. Cette théoricienne insiste sur l’importance de comprendre comment les personnes se réfèrent à leurs valeurs prioritaires, de manière à ce que la personne exprime sa santé et son devenir selon son expérience. La méthode que nous avons utilisée pour ce travail consiste en la réalisation d’une revue de la littérature. Six articles scientifiques ont été sélectionnés dont quatre qualitatifs et deux revues systématiques issues d’une recherche documentaire entre le 1er avril et le 31 mai 2015 à l’aide de deux moteurs de recherche, Cinahl et PubMed. Résultats. Trois thèmes pertinents sont ressortis tels que : l’apport d’informations et les facteurs influençant la communication, le développement des compétences à travers la formation et la posture de l’infirmière au sein d’une équipe interdisciplinaire. Cette évaluation prend tout son sens et laisse supposer que l’accompagnement en soins de soutien est un moment opportun pour l’infirmière afin de communiquer des informations claires, dont les personnes ont besoin pour déterminer leurs choix et les orienter dans leur démarche. Conclusion. Cette revue se penche sur la trajectoire de la maladie. Elle relève l’insatisfaction des besoins en communication chez les personnes atteintes de cancer et tente de comprendre comment l’infirmière s’engage auprès de la personne en s’appuyant de l’humaindevenant

Evolution im Aluminium-Guss von Fahrwerk-Komponenten

Werkstoff- und Prozessgrenzen beschränken unter Beachtung ökonomischer und ökologischer Aspekte den Leichtbau gegossener Fahrwerk-Komponenten aus Al-Si-Legierungen. Zunächst werden Bauteilgewicht und Wärmebehandlungsprozess als beeinflussbare Hauptbeitragsleister für Emissionen im Herstellprozess identifiziert. Zu deren Verringerung werden abhängig von der Belastungsart mögliche Mindestwandstärken abgeleitet, die für den Kokillenguss um 35 % reduziert werden. Dies gelingt durch Einsatz neuartiger, das Formfüllverhalten verbessernder Oberflächenstrukturierungen von Gießwerkzeugen bei Einhaltung von Konstruktionsregeln. Die Gesamtprozesszeit der Wärmebehandlung kann bei gleichbleibenden mechanischen Eigenschaften um 40 % verkürzt werden. Dabei erfolgt die Charakterisierung des Werkstoff- und Bauteilverhaltens unter dynamischer Belastung bei Parametervariation, da keine Korrelation zu den statischen mechanischen Kennwerten vorliegt

P300 as an auxiliary method in clinical practice: A review of literature

Cognitive functions can be assessed and followed up over a period of time with cognitive evoked potentials (CEP) P300. In this context, brainstem auditory evoked potentials (BAEP) are most commonly used, but visual evoked potentials (VEP) are utilized as well. The research in this area has demonstrated that these techniques could be used as a supplemental method in diagnostics of numerous diseases such as Alzheimer's disease, mild cognitive impairment, vascular dementia, epilepsy, craniocerebral trauma, Parkinson's disease, multiple sclerosis, and other degenerative diseases. In addition, P300 can also be used as an auxiliary method in the diagnostics of mental disorders conditions such as schizophrenia, panic disorders, narcotic drug addiction, nicotinism, alcoholism, etc. The method assists in monitoring the course of diseases leading to encephalopathy, such as liver and kidney damage and grave anaemia. The advantages of P300 testing are easy application, non-invasiveness, and an unlimited number of potential applications. Moreover, the results obtained with this method are measurable and can be compared

Structural Health Monitoring of Wind Turbine Systems: Data-based Lifetime Models Development for Integration into Control Systems

Aufgrund unterschiedlicher Lastprofile unterliegen technische Systeme individuellen Änderungen durch die Schadenserhöhung und die Änderungen von Systemparametern über die Einsatzdauer. Diese Änderungen führen zu einer Abnahme der Systemzuverlässigkeit und letztlich zum Funktionsverlust. Da die Alterung eines Systems unvermeidbar ist, sind sowohl die Identifikation von Effekten, die den größten Beitrag zum Funktionsverlust haben als auch die Vorhersage der verbrauchten bzw. verbleibenden Lebensdauer von zentraler Bedeutung zur Einleitung geeigneter Maßnahmen unter Berücksichtigung des momentanen State-of-Health (SoH). Diese Arbeit befasst sich mit der Entwicklung einer effizienten Strategie zur Bestimmung des SoH und der Lebensdauervorhersage ausgewählter Komponenten rekuperativer und alternativer Energieerzeugungssysteme. Konkret werden die Komponenten von Wind-Turbinen (WT) betrachtet. Elementare Bestandteile sind somit insbesondere die Anpassung von Betriebsbedingungen und die Steigerung der Lebensdauer durch adaptive Regelungsstrategien auf Basis des geschätzten SoH. Zentrales Ziel der Arbeit ist die Modellbildung der Funktionalität technischer Systeme also die Erstellung von Lebensdauermodellen, welches die Grundlage zur Entwicklung einer geeigneten Regelungsstrategie bildet. Der Konzept ist als das Safety and Reliability Control Engineering (SRCE) Konzept genannt und wurde erstmals im Jahr 1996 entwickelt und veröffentlicht. Das eingeführte SRCE-Konzept ermöglicht es, die Systemzuverlässigkeit zu beeinflussen und die Lebensdauer unter Ber¨ucksichtigung von Wissen bezüglich des aktuellen SoH zu steigern. Zur Entwicklung eines Lebensdauermodells ist es notwendig, die Zusammenhänge zwischen den Messergebnissen eines Structural Health Monitoring (SHM) Systems und der Zustandsdegradierung zu identifizieren. In diesem Kontext wird ein Schwerpunkt dieser Arbeit auf SHM von Windturbinen Komponenten gelegt, wobei besondere Aufmerksamkeit auf SHM Methoden gerichtet wird, die zur Überwachung von Rotorblättern, Lagern, Getrieben sowie Energiespeichern geeignet sind. In diesem Sinne werden nicht nur einzelne Komponenten in ihrer Gesamtheit Berücksichtigt, sondern auch die verschiedenen Einsatzmaterialien (Verbundwerkstoffe, metallische Strukturen). Anhand eines Simulationsmodells wird die Implementierung einer adaptiven Regelungsstrategie für eine Windturbine diskutiert, welche die Möglichkeit zur gleichzeitigen Verlängerung der Lebensdauer sowie Leistungsregelung illustriert. Gemäß den Voraussetzungen für eine adaptive Regelungsstrategien wird die Ermüdungslast von Windturbinen untersucht und in das Modell integriert. In diesem Fall wird der Reglerentwurf durch Wissen, welches aus der Untersuchung der Ermüdungslast resultiert, und der Restlebensdauervorhersage bedingt. Die in dieser Arbeit vorgeschlagene, zuverlässigkeitsorientierte Regelungsstrategie beeinflusst die Zuverlässigkeit des Systems durch an den aktuellen SoH angepasste Regelungsvorgänge. Außerdem werden drei neue, im Kontext dieser Arbeit entwickelte Ansätze zur Lebensdauermodellierung präsentiert. Diese greifen auf SHM Daten aus der Überwachung eines tribologischen Systems zurück. Zusätzlich zur Entwicklung der Lebensdauermodelle für das tribologische System werden Untersuchungen bezüglich verschiedener Schädigungsmechanismen und Ansätze zur Lebensdauermodellierung von Lithium-Ionen Batterien (LIBs) anhand experimenteller Daten eines LIB Prüfstand dargestellt und diskutiert. Der Hauptbeitrag dieser Arbeit liegt in der Entwicklung neuer Ansätze zur Lebensdauermodellierung und dem Nachweis, dass eine adaptive, zuverlässigkeitsorientierte Regelungsstrategie die Vermeidung von vorzeitigem Systemversagen, erhöhten Betriebs- sowie Wartungskosten als auch kritischer Situationen, die zu großen ökonomischen sowie menschlichen Verlusten führen, ermöglicht. Mit den drei vorgeschlagenen Lebensdauermodellen konnten die vorgegebene oder zufriedenstellende Vorhersagegenauigkeiten erzielt werden. Dabei sind jedoch die Anzahl der Modellparameter, die Modellkomplexität, die Genauigkeit des Models und die Anforderungen an die experimentellen Datensätze unterschiedlich. Diese vier Kriterien werden vor dem Hintergrund der Modellevaluierung und Anwendbarkeit auf reale Systeme diskutiert. Durch die Messung struktureller Lasten und des Effektes mechanischer Belastung auf die Systemzuverlässigkeit kann gezeigt werden, dass eine adaptive Regelungsstrategie die Reduktion struktureller Lasten, insbesondere der auf die Rotorblätter wirkenden flap-wise Biegemomente, ermöglicht und somit eine Möglichkeit zur Steigerung der Restnutzungsdauer darstellt. Dabei ist die Diskrepanz zwischen gewünschter und tatsächlicher Generatorleistung minimal. Die Ergebnisse zeigen, dass im Fall exzessiver struktureller Lasten am Ende der Lebensdauer die Regelungsziele im Kontext der Energieerzeugung geringfügig geopfert werden. Die dargestellten Ergebnisse wurden mit einem Simulationsmodell einer Windturbine erzielt.Technical systems experience different changes due to damage increase and the change of system parameters over service lifetime. These changes are caused by system exposure to different loading profiles, leading to decreased reliability and ultimately to the loss of functionality. Concerning inevitable aging of the system, it is important to examine effects with highest impact to reducing reliability and to predict the remaining or consumed lifetime of the system so that appropriate actions can be performed in accordance with actual State-of-Health (SoH). This thesis concerns the establishment of an efficient approach for determining the SoH and lifetime prognosis of particular components of recuperative and alternative power generation systems. Concretely, Wind Turbine (WT) systems are considered. The adaption of operation conditions in accordance to estimated current State-of-Health as well as extension of the lifetime through adapted control strategy is therefore an important part. The main aim of the thesis is modeling of functionality of technical systems through the establishment of lifetime models, which are prerequisite for the development of suitable control strategy. Such control concept is known as Safety and Reliability Control Engineering (SRCE) concept and is firstly introduced and published in 1996. Aforementioned concept enables affecting system’s reliability and the extension of the lifetime by integrating the knowledge about current SoH into the control strategy. To establish lifetime model, the measurements from Structural Health Monitoring (SHM) systems and their correlation to the degradation is necessary. In accordance with this, special emphasis in this thesis is given to SHM of wind turbine components, especially those SHM methods applicable to rotor blades, bearings and gearboxes, as well as energy storage devices. In this sense, not only an examination of the component itself but also an examination of its constituent materials, are taken in consideration (composite materials, metallic structures). Implementation of adapted control strategy illustrating simultaneously the possibilities for lifetime extension and power regulation are discussed using simulation model of wind turbine. In accordance with prerequisites for adapted control strategy implementation, wind turbine fatigue load is examined and integrated into the model. Controller design in this case is conditioned by the knowledge about examined fatigue load and predicted remaining useful lifetime. Reliability-oriented control strategy proposed in the thesis affects system’s reliability through adapted control actions in accordance with current SoH. Additionally, the development of three new lifetime modeling approaches taking in consideration SHM data from tribological system are presented in this thesis. Beside lifetime model establishment concerning tribological system, an examination of damage mechanisms and lifetime modeling approaches related to Lithium-Ion Batteries (LIBs) using experimental data from LIB test rig is illustrated and discussed. Main contribution of this thesis lies in the development of new lifetime modeling approaches and in proved possibility of adapted reliability-oriented control strategy to avoid premature failures of the system, increased operation and maintenance costs, as well as critical events leading to high economical and human resource losses. Obtained results concerning proposed lifetime models with regards to prediction accuracy are satisfying for all three proposed models. The number of model parameters, model complexity, prediction accuracy, and requirements set on experimental data sets used for model training vary. These four criterion are discussed in terms of model evaluation and determination of model applicability to real systems. By tracking structural loads and effect of induced mechanical stresses on system’s reliability, it is illustrated that structural loads, primarily flap-wise bending moments of rotor blades, are decreased through adapted control strategy providing extension of remaining useful lifetime. The discrepancy between desired and obtained generator power is held as less as possible. According to the results, control objectives related to power generation are slightly sacrificed, but only when the level of structural load is excessive and the system is close to its end of life. Presented results are obtained using simulation model of wind turbine

Methods and Applications of ChatGPT in Software Development: A Literature Review

This research paper explores the use of language models in software development that has gained significant attention in recent years. One of the most popular models is ChatGPT, a large language model trained by OpenAI. ChatGPT has been applied in some of the software development tasks, like programming Numerical methods, code generation, solving programming bugs, code completion and even in practicing for computer science exam. This paper presents a systematic review of the literature on the application of ChatGPT in software development. The review covers 12 studies that use ChatGPT in some fields of software development. We evaluate their results and the offering for the field. Overall, the findings of this review offer significant contributions to the current understanding and future direction of using ChatGPT in the domain of software development

1067. Comparative Effectiveness of Nafcillin or Oxacillin, Cefazolin, and Piperacillin/Tazobactam in Methicillin-Sensitive Staphylococcus aureus Bacteremia

Background: β-Lactam antibiotics are recommended as first line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness among β-lactam therapies in MSSA bacteremia patients that were exclusively treated with one antibiotic. Methods: This was a retrospective cohort study of patients hospitalized at Veterans Affairs (VA) medical centers with MSSA bacteremia from January 1, 2002 to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, or piperacillin/tazobactam (i.e., monotherapy with no changes in therapy). The primary outcome was 30-day mortality, and secondary outcomes were time to discharge, inpatient mortality, 30-day readmission, and 30-day S. aureus reinfection. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using unadjusted, quintile adjusted, and propensity-score (PS) matched (nearest neighbor, 0.05 caliper) Cox proportional hazards regression. Results: A total of 326 patients were included in the final analysis. When comparing nafcillin (n = 75)/oxacillin (n = 30) with cefazolin (n = 108), 30-day mortality was similar between groups (PS matched n = 40, HR 4.0, 95% CI 0.45–35.79), as were rates of the other outcomes assessed. When combining nafcillin/oxacillin with cefazolin, and comparing to piperacillin/tazobactam (n = 113), 30-day mortality was significantly lower in the nafcillin/oxacillin/cefazolin group (PS matched n = 66, HR 0.29, 95% CI 0.09–0.87). Inpatient mortality and 30-day mortality were significantly lower with nafcillin/oxacillin/cefazolin in PS-adjusted analyses (HR 0.29, 95% CI 0.11–0.73 and HR 0.23, 95% CI 0.10–0.50, respectively). Conclusion: In hospitalized patients with MSSA bacteremia, no difference in mortality was observed between nafcillin/oxacillin and cefazolin in patients that were exclusively treated with these monotherapies. However, higher mortality was observed with piperacillin/tazobactam as compared with nafcillin/oxacillin/cefazolin, suggesting that it may not be as effective as other monotherapies for MSSA bacteremia

Comparative Effectiveness of Exclusive Exposure to Nafcillin or Oxacillin, Cefazolin, Piperacillin/Tazobactam, and Fluoroquinolones Among a National Cohort of Veterans With Methicillin-Susceptible \u3cem\u3eStaphylococcus aureus\u3c/em\u3e Bloodstream Infection

Objective: Beta-lactam antibiotics are recommended as first-line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness of anti-MSSA therapies among bacteremia patients exclusively exposed to 1 antimicrobial. Method: This was a national retrospective cohort study of patients hospitalized in Veterans Affairs medical centers with MSSA bacteremia from January 1, 2002, to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, piperacillin/tazobactam, or fluoroquinolones (moxifloxacin and levofloxacin). We assessed 30-day mortality, time to discharge, inpatient mortality, 30-day readmission, and 30-day S. aureus reinfection. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using propensity-score (PS) matched Cox proportional hazards regression model. Results: When comparing nafcillin/oxacillin (n = 105) with cefazolin (n = 107), 30-day mortality was similar between groups (PS matched n = 44; HR, 0.67; 95% CI, 0.11–4.00), as were rates of the other outcomes assessed. As clinical outcomes did not vary between nafcillin/oxacillin and cefazolin, they were combined for comparison with piperacillin/tazobactam (n = 113) and fluoroquinolones (n = 103). Mortality in the 30 days after culture was significantly lower in the nafcillin/oxacillin/cefazolin group compared with piperacillin/tazobactam (PS matched n = 48; HR, 0.10; 95% CI, 0.01–0.78), and similar when compared with fluoroquinolones (PS matched n = 32; HR, 1.33; 95% CI, 0.30–5.96). Conclusions: In hospitalized patients with MSSA bacteremia, no difference in mortality was observed between nafcillin/oxacillin and cefazolin or fluoroquinolones. However, higher mortality was observed with piperacillin/tazobactam as compared with nafcillin/oxacillin/cefazolin, suggesting it may not be as effective as a monotherapy in MSSA bacteremia

Predictors of Mortality Among a National Cohort of Veterans With Recurrent Clostridium difficile Infection

Background: Though recurrent Clostridium difficile infection (CDI) is common and poses a major clinical concern, data are lacking regarding mortality among patients who survive their initial CDI and have subsequent recurrences. Risk factors for mortality in patients with recurrent CDI are largely unknown. Methods: Veterans Affairs patients with a first CDI (stool sample with positive C. difficile toxin(s) and ≥2 days CDI treatment) were included (2010–2014). Subsequent recurrences were defined as additional CDI episodes ≥14 days after the stool test date and within 30 days of the end of treatment. A matched (1:4) case–control analysis was conducted using multivariable conditional logistic regression to identify predictors of all-cause mortality within 30 days of the first recurrence. Results: Crude 30-day all-cause mortality rates were 10.6% for the initial CDI episode, 8.3% for the first recurrence, 4.2% for the second recurrence, and 5.9% for the third recurrence. Among 110 cases and 440 controls, 6 predictors of mortality were identified: use of proton pump inhibitors (PPIs; odds ratio [OR], 3.86; 95% confidence interval [CI], 2.14–6.96), any antibiotic (OR, 3.33; 95% CI, 1.79–6.17), respiratory failure (OR, 8.26; 95% CI, 1.71–39.92), congitive dysfunction (OR, 2.41; 95% CI, 1.02–5.72), nutrition deficiency (OR, 2.91; 95% CI, 1.37–6.21), and age (OR, 1.04; 95% CI, 1.01–1.07). Conclusions: In our national cohort of Veterans, crude mortality decreased by 44% from the initial episode to the third recurrence. Treatment with antibiotics, use of PPIs, and underlying comorbidities were important predictors of mortality in recurrent CDI. Our study assists health care providers in identifying patients at high risk of death after CDI recurrence

Minidoka Memorial Hospital Expansion

The Minidoka Memorial Hospital is the main hospital serving Minidoka County. Due to an increase in farming and traffic accidents, the emergency facilities are no longer adequate and require expansion